J
jayakrishninja
Guest
Hello
My name is Jay from San Jose, CA and I'm new to the forum. I'm posting a question on behalf of my wife who was taken to a HMO Provider for an emergency care (her toenail got separated & her little toe got fractured due to an impact to her foot). These are the list of events happened in chronological sequence
06/15/2014
My wife gets injured and then I rush her to the nearest hospital which happens to be a HMO Provider/Hospital
Since my wife was a non-member there, we were asked to register and then get admitted into Emergency
After almost a 40min wait, she's sent to Xrays department to get an Xray of her small toe
After another 40min+ wait, a physician comes in and confirms a fracture and also affirms that she should be able to clean the big toe nail wound and disappears
A lab assistant does a quick saline clean on the wound and puts a clunky bandage on the wound
After another 15 mins, the physician comes in and comments about the bandage and removes and resticks another bandage in place (Agonizing!!!)
After all this, the lab assistant returns and gives her a footwear to support her broken toe and also gives her a crutch (which she didnt need that time)
The physician urges my wife not to remove the bandage for a few days and we leave
We go and she gets into our apartment and 2 days later when she gets up, the bandage comes out
06/17/2014
We head back to the same hospital and try to meet with the physician. She's not present so we are asked to get admitted again in ER and another physician meets us and shows us how to clean the wound and put a firm bandage
At this time we are charged $130 (the person who bills us tells us that the remaining would be charged to her Aetna insurance account) and we leave
07/20/2014
Bill 1: We get a bill of $1275.17 for services including Xray, ER room, some preventive care and vaccination (she had a TT shot when she got admitted). It looks like Aetna paid about $342 out of $1617 and we were billed to pay $1275 due in a month (8/17)
08/08/2014
Bill 2: We get another bill of $160.38 for the physician's services-fee (total bill of $460, of which Aetna covered $299), due upon receipt
08/16/2014
Given that we get closer to the due date, we go directly to the hospital for explanation. Upon getting a very vague explanation, the person accepted that the billing was ridiculous and asked us to pay the bill and raise a dispute/grievance by filling out a grievance form (if at all there was a way to get a discount).
So we pay $1275+$160= $1435 on the same day and get a receipt also on the same day.
We walk out after collecting the grievance form
09/07/2014
Bill 2a: We get another bill of $160.38 for the physician's service-fee (its exactly a clone of the Bill 2) with a due upon receipt
We ignore this (as we already paid it)
09/22/2014
We get a courtesy notice of pending bad debt (letter dated 09/17) from the hospital asking us to pay the due of $160.38 (from Bill 2a) immediately to avoid getting it to collections
09/23/2014
We call the customer service number on the above mentioned letter to check why we were sent the same bill again. He puts us on a brief hold and confirms that it was an error and he affirmed that the balance was indeed $0 and he has removed all the duplicate entries. He also confirmed we don't owe anything (we had recorded this)
On the same day afternoon, we go to a nearby branch of the same brand of hospital to submit the grievance form and also let him know of the billing messup. He acknowledges and takes our explanation and affirms that we'll not get any more bills (since he checked and confirmed that we don't owe anything).
Additionally, he also told us that there would be a grievance officer who'll investigate our matter and call us in the next 10 business days
10/14/2014
No call received from any "Grievance Officer" till date
We receive Bill 2b: for another $160.38 (with a cloned description, date etc., from Bill 2/2a). This time the bill dates 10/07 and the due date printed as 11/06
We have not called the customer service yet and I'm sure they'll send another collection notice if we ignore this
----------------------------XXXXXXXXXXXXXXXXX-----------------------
We feel we are being harassed and taken for a ride due to their systemic issues (or it could be intentional). We need some legal advise to help us decide if we can invest the time and money to sue this HMO service provider/hospital. We are beyond frustrated and it feels like this hospital doesn't even care about our time and money.
We want to know if
1. We can sue this company for the billing messup and the harassment we are experiencing (we have all versions of the receipt and also the recording of the conversation with the customer service agent confirming that Bill 2a was indeed a duplicate)
2. It would cost us a lot of money and time to sue them, if we decide to do so
3. What are the odds of we winning the case?
4. What will happen if we win/lose the case
Your guidance is much appreciated.
Thanks and regards
Jay
jayakrishninja@gmail.com
My name is Jay from San Jose, CA and I'm new to the forum. I'm posting a question on behalf of my wife who was taken to a HMO Provider for an emergency care (her toenail got separated & her little toe got fractured due to an impact to her foot). These are the list of events happened in chronological sequence
06/15/2014
My wife gets injured and then I rush her to the nearest hospital which happens to be a HMO Provider/Hospital
Since my wife was a non-member there, we were asked to register and then get admitted into Emergency
After almost a 40min wait, she's sent to Xrays department to get an Xray of her small toe
After another 40min+ wait, a physician comes in and confirms a fracture and also affirms that she should be able to clean the big toe nail wound and disappears
A lab assistant does a quick saline clean on the wound and puts a clunky bandage on the wound
After another 15 mins, the physician comes in and comments about the bandage and removes and resticks another bandage in place (Agonizing!!!)
After all this, the lab assistant returns and gives her a footwear to support her broken toe and also gives her a crutch (which she didnt need that time)
The physician urges my wife not to remove the bandage for a few days and we leave
We go and she gets into our apartment and 2 days later when she gets up, the bandage comes out
06/17/2014
We head back to the same hospital and try to meet with the physician. She's not present so we are asked to get admitted again in ER and another physician meets us and shows us how to clean the wound and put a firm bandage
At this time we are charged $130 (the person who bills us tells us that the remaining would be charged to her Aetna insurance account) and we leave
07/20/2014
Bill 1: We get a bill of $1275.17 for services including Xray, ER room, some preventive care and vaccination (she had a TT shot when she got admitted). It looks like Aetna paid about $342 out of $1617 and we were billed to pay $1275 due in a month (8/17)
08/08/2014
Bill 2: We get another bill of $160.38 for the physician's services-fee (total bill of $460, of which Aetna covered $299), due upon receipt
08/16/2014
Given that we get closer to the due date, we go directly to the hospital for explanation. Upon getting a very vague explanation, the person accepted that the billing was ridiculous and asked us to pay the bill and raise a dispute/grievance by filling out a grievance form (if at all there was a way to get a discount).
So we pay $1275+$160= $1435 on the same day and get a receipt also on the same day.
We walk out after collecting the grievance form
09/07/2014
Bill 2a: We get another bill of $160.38 for the physician's service-fee (its exactly a clone of the Bill 2) with a due upon receipt
We ignore this (as we already paid it)
09/22/2014
We get a courtesy notice of pending bad debt (letter dated 09/17) from the hospital asking us to pay the due of $160.38 (from Bill 2a) immediately to avoid getting it to collections
09/23/2014
We call the customer service number on the above mentioned letter to check why we were sent the same bill again. He puts us on a brief hold and confirms that it was an error and he affirmed that the balance was indeed $0 and he has removed all the duplicate entries. He also confirmed we don't owe anything (we had recorded this)
On the same day afternoon, we go to a nearby branch of the same brand of hospital to submit the grievance form and also let him know of the billing messup. He acknowledges and takes our explanation and affirms that we'll not get any more bills (since he checked and confirmed that we don't owe anything).
Additionally, he also told us that there would be a grievance officer who'll investigate our matter and call us in the next 10 business days
10/14/2014
No call received from any "Grievance Officer" till date
We receive Bill 2b: for another $160.38 (with a cloned description, date etc., from Bill 2/2a). This time the bill dates 10/07 and the due date printed as 11/06
We have not called the customer service yet and I'm sure they'll send another collection notice if we ignore this
----------------------------XXXXXXXXXXXXXXXXX-----------------------
We feel we are being harassed and taken for a ride due to their systemic issues (or it could be intentional). We need some legal advise to help us decide if we can invest the time and money to sue this HMO service provider/hospital. We are beyond frustrated and it feels like this hospital doesn't even care about our time and money.
We want to know if
1. We can sue this company for the billing messup and the harassment we are experiencing (we have all versions of the receipt and also the recording of the conversation with the customer service agent confirming that Bill 2a was indeed a duplicate)
2. It would cost us a lot of money and time to sue them, if we decide to do so
3. What are the odds of we winning the case?
4. What will happen if we win/lose the case
Your guidance is much appreciated.
Thanks and regards
Jay
jayakrishninja@gmail.com
